Efficacy and safety of intermittent hemodialysis using citrate as anticoagulant: a prospective study

Abstract

The use of trisodium-citrate for regional anticoagulation of the extracorporal circuit during renal replacement therapy (RRT) has received increased interest, particularly in critically ill patients with increased risk of bleeding. Continuous renal replacement therapies are the most extensively investigated and used procedures in this regard. However, when patients recover from critical illness, RRT is often switched to intermittent procedures. In this prospective study, we investigated the efficacy and safety of citrate anticoagulation during intermittent hemodialysis (IHD) performed with a standard roller blood pump device. We treated 11 critically ill patients with acute renal failure. These patients received a total of 31 intermittent IHD treatments. The targeted IHD treatment time was 6 h (4.5 l/h treatment dose). For anticoagulation, a 4% trisodium-citrate solution was continuously infused into the arterial line of the extracorporeal circuit. A calcium-free, lactate-based dialysis solution was used in all treatment procedures. Calcium was continuously substituted via a separate central line. Electrolyte and acid-base changes as well as the cardiovascular hemodynamics were analyzed. All patients achieved the targeted filter life time. Filter clotting did not occur. Electrolytes and acid base values were well-maintained throughout the study period. Particularly metabolic derangements were not observed. All treatments were hemodynamically well-tolerated. Intermittent hemodialysis with citrate anticoagulation can be safely applied in critically ill patients at high risk of bleeding.